Posts Tagged ‘lower back pain’

Written By
Kevin Murray, M.A. (pending)
Movement Masterminds – CEO
Function First – Director of Education
2012 CSEP CPT of the Year

THE SIZING APPEAL

The Small, Medium, Large concept to clothing that all department stores embody seems like a straightforward, pragmatic approach to sizing. If the article of clothing fits, you’re golden; If not, you’re either going up a size, or down. But what about those that fall between the cracks? Or above, or below those labels?

I constantly run into this predicament. Sometimes a small is too tight. Other times a medium drapes off my shoulders, which was a good look for me in the 90’s with skateboard in hand – not so cool anymore. I often wish there was a size “smedium”, right in between at that “sweet spot.”

Perhaps you can relate… maybe your frame deserves a “marge”, right in between medium and large.

ATTENTION ALL “SHOPPERS”:
DUALISTIC THINKING IS OUT-OF-DATE & NO LONGER IN STOCK!

Am I really posting up an article about clothing? As much as I dig fashion, the department store approach is actually a metaphor for the movement industry in many respects, and its modus operandi to complex pain problems.

For example, you may be familiar with conceptualized strategies such as:

A dualistic, department store approach emphasizes that although all individual’s move differently and come from different backgrounds and cultures, there are essentially only 3-types of people – small, medium and large. Chronic pain on the other hand is complex, embodying dynamic dimensions that encompass myriad variables expanding beyond the optics of biomechanical and connective tissue principles alone. A diverse approach to sizing is needed.

GEORGE ENGEL’s BPS APPROACH:
TAILORED FOR ALL SHAPES AND SIZES – SINCE 1977

Progressing beyond (but not excluding) biomechanics and connective tissue, a 3-dimensional approach to working with clients’ in pain include a vast variety of biopsychosocial ingredients and considerations:

are all in play when considering the Neuromatrix and its influence on how we collaborate with, and coach our clients’ in pain.

SUIT YOU, SIR

Working with the chronic pain demographic is much like being a tailor. Each individual comes in with unique dimensions and constraints; different outcomes and desires. A tailor is seeking to understand where specific attention needs to be placed. A tailor asks questions like:

Why doesn’t their clothing fit?
Have they ever been to a tailor before? If so, what was their experience?
How will we know when a successful amendment has taken effect?
What is their specific outcome?

A tailor considers multiple dimensions into his/her analysis and thought process, outside the shackles of unidimensional constraints. Instead, diversification is personified, driven by the uniqueness of each individual and their articles of clothing.

Individuals’ in pain each have their own unique articles of clothing (yes, we’re still talking metaphorically here) that need specific attention and consideration. If you can meet your clients’ unique needs, much like a tailor does, than you’ll have accomplished something truly special in your clients’ eyes.

Amidst the waves of uncertainty that accompany working with individuals’ experiencing chronic pain and relinquishing a dualistic/department store thought-process, above all remember you’re interacting with another individual – and not a mechanistic instrument. Be kind, be empathetic, and as often as possible seek to understand rather than judge.

“The quality of the therapeutic relationship appears to be more predictive of success than any theoretical approach of the helper.” John Nuttall

Shopping is one of the activities that we most frequently hear about regarding aggravating our clients’ lower backs. And what do we do during the holiday season? We shop.

The stopping and starting and stopping again. The standing around in long lines with no reprieve for our back muscles.

Couple that with the other stresses associated with the holidays and the factors that can ramp up lower back pain/tightness can get the best of us. So if you are looking for a quick and effective way to reduce tension in your lower back, you’ll want to watch this video.

Derahn shows you how to relax your lower back muscles WITHOUT stretching. It is counter intuitive for most people but it gets the job done because it goes with the tightness instead of away from it.

That’s the good news. It will relax the back muscles and for many people reduce or eliminate upper and lower back pain.

The bad news is that this is not a long term solution. It does not address the many, many bio-psycho-social factors associated with pain.

However, any time you can mitigate the discomfort, keep it from escalating and take control-you are doing something very positive for your long term success.

When we prescribe a corrective exercise to our client, there are multiple factors that go into the decision making process. For an exercise to be appropriate for a client at any given time, we have to consider the 4 characteristics of every exercise:

*biomechanical
*physiological
*neurological
*psychological

The Four Point Rotations is an exercise when looked at analytically, can successfully address these characteristics for many client types. This is an effective exercise to emphasize hip motion while unloading the spine and decreasing the threat for those with lower back pain.

The bio-psycho-social model to chronic pain is evidently clear in the literature and we have made great strides in applying this model to our clients and our teaching.

What is also evidently clear, is that if you do not include the “bio” in the conversation, you will have a very difficult time helping the client relate a “known”-the biology/biomechanics of the body-to an unknow-the psycho/social aspects of the model.

The bio is simply the known because that is what the paradigm has been for the hundreds of years now. The pysco/social aspect is still very new for the general public (and unfortunately many medical professionals).

The following video clip is from a presentation I did titled: 25 Things Your Client Needs to Know About Lower Back Pain. The talk was presented to address the many misconceptions our clients and potential clients have regarding lower back pain. This clip addresses a few of those misconceptions.

The video below is taken from a live presentation that I did at the Fit Pro Convention at Loughborough University in England a little while back. The clip is from the presentation “25 Things Your Client Needs to Know about Lower Back Pain”.

In The Pain-Free Program I discuss people wanting to identify a “villain” to give them some sense of confirmation to their pain. Imaging studies such as an MRI is a route for many to try to find this villain. What most of our clients are surprised to hear is that the results of their MRI has very little to do with the exercise intervention.

Earlier this month I presented at the IDEA World Fitness Conference. It is a conference I’ve had the privilege of presenting at for quite a few years. Fitness professionals from around the globe come to learn and connect.

One of my presentations this year that was filmed by IDEA to share with others was,”The 25 Things Your Client Must Know About Lower Back Pain”.

I thought I would share with you the list of items in the presentation. Of course during the presentation each topic was discussed and explained in detail. But I’m sure you’ll find some great tips from the list alone!

1. A bad back is not always a weak back.

2. A weak back can be a precursor to a bad back.

3. Muscle endurance is initially more important then muscle strengthening for your back.

4. Acute episodes of back pain respond better to ice than heat.

5. Positive finding on an MRI often have less to do with your pain than you might think.

6. Stretching alone is an incomplete answer to solving your back problems.

7. Your body adapts to exercise, so doing the same “back” exercises for months or years has diminishing returns.

8. Chronic back pain can be months or years in the making.

9. Sleeping on your stomach is good for some people.

10. Lower back pain can be caused by your feet.

11. Lower back pain can be caused by your neck.

12. Never roll out of bed and immediately stretch in the morning.

13. Pulling your knees to your chest may be bad for your back.

14. Lumbar supports when sitting are helpful.

15. More serious medical problems sometimes mimic lower back pain.

16. Stretching your hamstrings when you have sciatica can make the symptoms worse.

17. Pregnancy and monthly cycles with increased hormone production can decrease the stability of the sacroiliac joint in women leading to LBP.

18. The best back exercises are those that are designed for you following an evaluation.

19. An old injury to another part of your body can contribute to your back pain.

20. Lying on your back with your hips and knees bent to 90 degrees and legs supported can passively mitigate back pain.

21. Repeated work or recreational postures or movements will lead to imbalances in your body and impact the back.

22. Back surgery can almost always be rescheduled.

23. If medication is your only intervention, you’ll be medicating for life.